Clinical UM Guideline

Subject:

Seat Lift Mechanisms

Guideline #:

CG-DME-25

Current Effective Date:

01/13/2015

Status:

Reviewed

Last Review Date:

11/13/2014

Description

This document addresses seat lift mechanisms, assistive devices used in the home to lift a person's body from a sitting position to a standing position or to lower the individual from a standing to a sitting position.

Note: Please see the following related documents for additional information:

A seat lift mechanism is considered medically necessary when all the following criteria are met:

The individual must have severe arthritis of the hip or knee(s) or have a severe neuromuscular disease; and

The seat lift mechanism must be a part of the physician's course of treatment and be prescribed to effect improvement or arrest or retard deterioration in the individual's condition; and

The individual must be completely incapable of standing up from a regular armchair or any chair in their home; and

Once standing, the individual must have the ability to ambulate.

Note: Documentation that an individual has difficulty or is even incapable of getting up from a chair, particularly a low chair, is insufficient justification for a seat lift mechanism. Most individuals who are capable of ambulating can raise up out of an ordinary chair if the seat height is appropriate and the chair has arms.

Not Medically Necessary:

A seat lift that operates by spring release mechanism with a sudden, catapult-like motion and jolts the individual from a seated to a standing position is considered not medically necessary.

A seat lift mechanism is considered not medically necessary when the criteria listed above are not met.

Coding

The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

Individuals with impaired mobility often require physical assistance in lifting and transferring. Numerous medical conditions (such as, arthritis, muscular dystrophy, and neuromuscular diseases) can lead to limited mobility as a result of pain, joint stiffness or muscle weakness. Individuals are often not able to move from a sitting position to a standing position without the assistance of another person or a device. Devices such as seat lift mechanisms have been employed to ease transfers and prevent injuries to the individual, caregiver, or both (CMS, 2005). These devices are utilized in the individual's home or place or residence. In establishing medical necessity for the seat lift, CMS states the seat lift must be included in the physician's course of treatment, that it is likely to effect improvement or arrest or retard deterioration in the individual's condition, and that the severity of the condition is such that the alternative would be chair or bed confinement (CMS, 1989).